MUNCIE, Ind. (AP) — The sight of two police officers walking toward her front door on June 30, 2001, told Sheri Hole all she needed to know about her missing husband.

The imprint of Jeff’s gun clear on her mind, she realized she couldn’t meet the officers at the door. She couldn’t hear them say it — suicide.

“I was in shock, really,” she said. “My mother had been with me and she met the officers before they got to the door. I heard one of them say, ‘he’s gone’ and I didn’t know what to do.

“But when I look back, I can see he was depressed. He didn’t know what to do about it. There’s a stigma, especially back then, to talk about being depressed, to talk about being suicidal. Now it makes me wonder … if he had someone to talk to, would this have happened?”

Suicide often causes family members and friends to question all they thought they knew about their loved one. The Holes were no different.

From anger to denial to acceptance, each stage of grief prompted them to ask what happened to cause Jeff Hole to fall into a depression so deep, he could no longer see his life was worth living.

“I used to be angry at him. I used to think, ‘he didn’t feel he could talk to me about this?'” Hole told The Star Press (http://tspne.ws/175MNHr ). “But now, I’m focused on helping other people who are survivors of suicide. I want them to know (suicide) happens a lot more than we want to admit. And it is 100 percent preventable.”

Suicide can touch any family.

Suicide continues to grow in every ethnic and racial population in the United States, and although more attention is given to preventing homicides in communities, people are more likely to die from a suicide than murder.

In 2010, 16 Delaware County residents committed suicide. That number dropped to 13 in 2011, but rose back to 16 in 2012.

To date, seven residents have taken their lives this year.

County coroner Scott Hahn has said “the only pattern I’ve noticed with these deaths is that there is no pattern.”

They are men, women, old and young, and they come from different ethnic groups and various income levels. Nothing indicates suicide strikes one community over another.

Hahn noted there are times when investigating car accidents and drug overdoses, it appears the extent of risky behavior has him and others questioning whether suicide was intended.

“Sometimes, you see a severe car accident when no one else is on the road and only the driver is in the car and you wonder,” he said.

What causes someone to end their life varies from person to person, but psychologists and psychiatrists suggest a “triggering” effect traditionally sets the mind in tailspin: a loss of a job, the end of a romantic relationship, moving to a new community.

These events don’t cause a suicidal thought, but can set someone in an already depressed state to put into action an idea they’ve already considered.

“People can look at these numbers — 13 suicides for example — and think that’s not very many. That’s the state average. But, really, one is too many,” said Christopher Drapeau, a Ball State University doctoral student in educational psychology. He is also co-chairperson of the Suicide Prevention Coalition of East Central Indiana with Hole.

“What we need to do is ask questions,” Drapeau said. “Ask someone if they’re thinking of committing suicide. Sometimes, people think they’re putting that idea in someone else’s mind, but you’re not. Really, we’re not going to prevent suicides in Delaware County unless we talk openly about mental health. And we need to end the stigma to do that.”

When Hole finally accepted her husband had committed suicide and was ready to address the topic with her three children, her mother asked what Hole thought was an intriguing question.

“She asked me, ‘Well, they won’t put it in the paper that it was a suicide, will they?’ ” Hole said. “I told her I didn’t know because I didn’t think so and I wasn’t thinking about that. Then she said, ‘Well, if anyone asks me, I’m going to say his heart stopped.’ Who knows what she was thinking when she said that. But she definitely didn’t want people to know. There’s a stigma about mental health, depression and definitely suicide. But I didn’t care. I wanted to talk about it.”

She has gone on to form a suicide support group for relatives — survivors, Hole said — who hope to meet others who can relate to their experience.

Mental health advocates agree there is a “chicken or the egg” situation when it comes to ending negative attitudes about suicide.

In order to end the stigma, more families need to talk openly about their experiences. But families don’t want to speak openly, because of the stigma.

“It’s a serious issue for all of us because it affects so many people. Not only the close family members of the person who has died, but also their friends, their co-workers or classmates, their acquaintances,” said Pat Bennett, a member of the Delaware County chapter of the National Alliance for Mental Illness.

Bennett, a retired nurse, added: “There is nothing to be ashamed of, but those left behind believe there is.”

Various psychological surveys indicate family members who have survived their relative’s suicide often think they will be scorned for not doing all they can to save their loved one’s life. Others fear the public will judge them for having someone who committed suicide in their family.

In recent months, death by suicide has gained national attention, indicating a break in the stigma.

Rick Warren, author of “The Purpose Driven Life” and pastor of Saddleback Church in southern California, lost his son by suicide in April.

On July 27, Warren preached his first sermon since his son’s death, calling on his congregation of 10,000 to address mental health and suicide in society.

“It’s amazing to me that any other organ in your body can break down and there’s no shame and stigma to it,” The Los Angeles Times reported Warren as saying. “But if your brain breaks down, you’re supposed to keep it a secret.”

Local advocates applaud Warren’s sermon and ask for local faith and civil leaders to do the same.

“This stigma is horrible. People don’t understand that suicide is preventable but only if we allow people to be comfortable talking about how they are mentally and emotionally,” said Mary Bedel, a former president of the Indiana NAMI chapter.

She is currently president of the local NAMI affiliate. “We can think about this in the way people view cancer. There used to be a horrible stigma against people suffering from cancer, but with education and spreading awareness, people have been more open to speaking about cancer and how to prevent it.

“We need to do more of that work with suicide and mental health.”

During the latter weeks of April and the start of May, Delaware County law enforcement officers participated in a “Crisis Intervention Training,” organized by NAMI.

Facilitators hoped to educate officers about the varying degrees of mental health issues, including suicide, and how to respond to these concerns when called to assist residents.

The vital piece of the suicide training was to ask residents whether they planned to commit suicide.

“You hear about calls to the police from people who keep saying they’re going to kill themselves,” said Bennett, who was a facilitator during the training. “It may be easy for officers not to take this seriously, but we need them to. This training taught them more about mental health issues and what may make people do these things.”

Along with the Crisis Intervention Training, NAMI representatives and other mental health advocates have been involved in “QPR” training for local educators: Question, Persuade and Refer.

“We need to start looking at mental health as something we can address. When we ask people what’s going on, persuade them not to harm themselves and refer them to places that can help them like Meridian or other behavioral health facilities, we’re doing a lot,” she said. “We’re showing people we want them to live. They are worth it.”

Local members of NAMI as well as members of the ECI Suicide Prevention, which include representatives from Meridian Health Services and other behavioral health professionals, also call on residents with a depressed loved one “to get the guns out of the house.”

The New England Journal of Medicine reported that more than 53 percent of suicides are inflicted by use of a firearm, averaging more than 50 suicides per day.

Unlike other suicide attempts, a shooting is instant and rarely offers time to save someone’s life.

“I’m not saying people shouldn’t have a right to own guns. But if you think someone in that house who is depressed doesn’t know where that gun is, you’re wrong,” Bennett said. “Hiding it isn’t good enough. When we see how many people commit suicide by shooting themselves, we know we have to do something about guns.”

Hole and other mental health advocates also hope to create a “Mental Health Team” to work with local law enforcement in the same manner as the sexual assault team.

She and other professionals and advocates would meet with residents the officers suggest as needing mental health assistance.

They would also apply the QPR process through discussions with residents to get them the help they need — the help she wished her husband could have received more than a decade ago.

“His suicide really caused me to want to help other people,” Hole said. “I’ve realized life does go on … and it’s better when you help other people go through their pain. I’m learning that life is about going through pain and becoming stronger because of it. I’m happy to do what I can to help.”

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